The intersection of diplomacy and public health: the role of health attachés in the United States government’s global engagement Matthew Brown, MPS, Office of Global Affairs, US Department of Health and Human Services Craig Shapiro, MD, MPH, Office of Global Affairs, US Department of Health and Human Services Alicia Livinski, MPH, MA, National Institutes of Health Library Thomas Novotny, MD, MPH, San Diego State University Jimmy Kolker, Ambassador (ret.), MPA, Office of Global Affairs, US Department of Health and Human Services The views expressed in this presentation are those of the authors’ and do not reflect the official policy or position of the US Department of Health and Human Services, National Institutes of Health or San Diego State University

What is global health diplomacy (GHD)? Global health diplomacy is a political activity that meets the dual goals of improving health while strengthening relations among nations OGA provides technical advice on health policy and program issues: Advises the Secretary in the development of policy related to global health, social welfare and family issues Directs and coordinates international activities to ensure alignment with the Secretary’s vision, the Department’s global priorities, and overall U.S. foreign policy Facilitates coordination and collaboration across HHS OpDivs, StaffDivs and with other USG Agencies Works with relevant stakeholders to ensure that international policies and programs are grounded in the best possible science OGA does not usually: Make grants Implement programs Conduct research   Adams V, Novotny TE, Leslie H. Global Health Diplomacy. Medical Anthropology. 2008/10/28 2008;27(4):315-323

USG Participants in GHD U.S. Department of State, Office of Global Health Diplomacy (formerly the Global Health Initiative office) U.S. Department of Health and Human Services (and various Staff/Operating Divisions) U.S. Department of Defense U.S. Agency for International Development Other federal agencies who work with global health issues

GHD & HHS Lead US Government agency on health is the Department of Health and Human Services (HHS). In HHS, global health matters are coordinated by the Office of the Global Affairs (OGA) Many HHS divisions have global health offices: CDC Center for Global Health NIH Fogarty International Center; NIH/NCI Center for Global Health FDA International Program Office HRSA Office of Global Health Affairs

GHD & HHS Health Attachés are HHS employees who are posted in U.S. Embassies of countries of strategic importance to the Department and U.S. Government Represent the HHS Secretary and advance the science and practice of global health diplomacy, supporting Ambassador’s global health agenda and U.S. foreign policy objectives abroad

1948 JAMA article first mentions a Health Attaché assigned to Embassies in Paris, Brussels and The Hague. The role of Health Attachés grew out of the practice of having medical officers stationed at Embassies who not only provided medical care for diplomatic personnel stationed in a foreign country but also reported on issues of public health concern, such as outbreaks and local capacity to prevent or treat illnesses. For the United States, Health Attachés assigned to embassies abroad are group of professionals who have supported the improvement of global health policy for decades. HA have been instrumental in helping to launch the major global health initiatives of the last decade – negotiating with host country government, among U.S. government agencies, and with multilateral institutions - PEPFAR - PMI - Global Fund for HIV/AIDS, TB and Malaria Sanders. First Public Health Attache Appointed. JAMA. 1948;138(10):761

Why Health Attachés (HA)? New Diplomacy (QDDR) – diplomacy needs to expand beyond commercial, military, and political affairs U.S. Ambassadors increasingly need and want technical advice and program leadership focused on health This function is often delivered through a combination of efforts by: State Dept. Economic, Science, Technology and Health Officer CDC Country Director USAID Health Officer State Dept Local or Regional Medical Officer (primary care physician for Embassy community and families) Ambassadors increasingly need and want advice and program leadership focused on health. Where there is no Health Attaché, this function is often shared through a combination of efforts by an Economic officer, Science, Technology and Health Officer, PEPFAR or GHI coordinator, CDC Country Director and/or USAID Health Officer. OGA does receive requests for HAs to serve in other courtiers, however budget does not permit us to fill all request OGA has appointed some HHS Country Representatives – to serve in a limited function from existing staff already deployed on the ground – OGA has appointed HHS CRs in: Guatemala Thailand Vietnam Kenya Jones K-A. New Complexities and Approaches to Global Health Diplomacy: View from the U.S. Department of State. PLoS Med. 2010;7(5):e1000276.

Who is a Health Attaché? “A Health Attaché is a diplomat charged with reporting on health issues of concern for the U.S. Government, coordination of U.S. health policy and supporting the multiple agencies of HHS engaged in global health.” A health attaché is a diplomat who collects, analyses, and acts on information concerning health in a foreign country or countries.   Brown M, Mackey TK, Liang BA. Global health diplomacy and management mechanisms of US-China public health collaborations in China: Lessons for emerging markets. J Commercial Biotech 2012; 18(4):44-50.

Health Attachés & HHS = 5 Current Health Attachés Geneva Kabul Beijing Baghdad Hanoi New Delhi Addis Ababa Previous HAs: Ethiopia – African Union Vietnam – Regional Afghanistan – health system building Iraq – health system building Brasilia Pretoria = 5 Current Health Attachés = 4 Previous Health Attachés

Role of Health Attachés Report on local health issues that impact USG global health policy ‘Go-to’ person for health matters for host country and U.S. Ambassador & Embassy Negotiate and follow-up on bilateral and multilateral agreements and treaties Facilitate and coordinate public health research, technical assistance & information sharing Develop professional contacts of value to the USG

Role of Health Attachés Support high level global health delegations -- meetings Look for opportunities where the USG has capacity to address public health issues Monitor and encourage adherence to international conventions Serve as a bridge between domestic and international health issues and actors

Career of Health Attachés HAs are funded by HHS HAs have offices within the U.S. Embassy and carry a diplomatic title Career of HA – most drawn from HHS agencies and serve one or more tours Training and skills of HA – most have advanced training in public health/medicine, extensive field and program experience, and skills in policy analysis and negotiation OGA is working on creating a ‘global health career track’ within the Department

Health Attachés future Post 2015 Millennium Development Goals Increasing role of BRICS (Brazil, Russia, India, China and South Africa) Middle income countries want expanded collaboration in health & specifically HHS Expanding importance of Non-Communicable Diseases (NCDs) Health security and pandemic preparedness

Questions? matthew.brown@hhs.gov Thank you. Questions? matthew.brown@hhs.gov